Selective Serotonin Reuptake Inhibitor (SSRI) updated on 07-01-2025

Macrosomia (> 4000g)

R analysis
id Study   Lib. in paper Exposition period    Study type 
 Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S7473
R23249		 Skalkidou (Controls unexposed, disease free), 2020 Birthweight above 4000gr during pregnancy (anytime or not specified) population based cohort retrospective unexposed, disease free excluded Adjustment: No Monotherapy: no or not specified 0.88 [0.83;0.93] C
excluded (control group) 		1,353/8,512   46,661/263,996 48,014 8,512
ref
S7829
R23245		 Skalkidou (Controls unexposed, sick), 2020 Birthweight above 4000gr during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: No Monotherapy: no or not specified Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified 0.87 [0.81;0.93] C 1,353/8,512   5,060/28,317 6,413 8,512
ref
S12918
R49001		 Gungor (Controls exposed to Mirtazapine), 2019 Macrosomia (a birth weight higher than 4000 g) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No Monotherapy: SSRI only 2.07 [0.09;45.58] C
excluded (control group) 		2/40   0/16 2 40
ref
S8158
R25128		 Gungor (Controls unexposed, disease free), 2019 Macrosomia (a birth weight higher than 4000 g) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No Monotherapy: SSRI only 1.16 [0.10;13.52] C
excluded (control group) 		2/40   1/23 3 40
ref
S8159
R25134		 Gungor (Controls unexposed, sick), 2019 Macrosomia (a birth weight higher than 4000 g) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No Monotherapy: SSRI only Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified 3.00 [0.14;65.35] C 2/40   0/23 2 40
ref
S6999
R19853		 Reis (Controls exposed to TCA), 2010 High birthweight (>4500 g) 2nd and/or 3rd trimester population based cohort retrospective exposed to other treatment, sick excluded Adjustment: No Monotherapy: SSRI only 1.29 [0.81;2.05] C
excluded (control group) 		165/4,809   21/784 186 4,809
ref
S5410
R17513		 Reis (Controls unexposed, NOS), 2010 High birthweight (>4500 g) 2nd and/or 3rd trimester population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: SSRI only 0.89 [0.70;1.04] 165/4,809   46,050/1,062,190 46,215 4,809
ref
S515
R16344		 Pastuszak - Fluoxetine (Controls unexposed, NOS), 1993 Birth weight > 4000g 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No Matched Monotherapy: SSRI only 1.74 [0.71;4.23] C 15/84   9/81 24 84
ref
Total 4 studies 0.87 [0.82;0.93] 52,654 13,445
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

StudyTE95% CIn casesn exposedweightROBABCDEF Skalkidou (Controls unexposed, sick), 2020Skalkidou, 2020 1 0.87[0.81; 0.93]6,4138,51290%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Gungor (Controls unexposed, sick), 2019Gungor, 2019 2 3.00[0.14; 65.35]2400%ROB confusion: seriousROB selection: unclearROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Reis (Controls unexposed, NOS), 2010Reis, 2010 3 0.89[0.70; 1.04]46,2154,80910%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Pastuszak - Fluoxetine (Controls unexposed, NOS), 1993Pastuszak - Fluoxetine, 1993 4 1.74[0.71; 4.23]24840%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 0% 0.87[0.82; 0.93]52,65413,4450.210.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick; 2: Controls unexposed, sick; 3: Controls unexposed, NOS; 4: Controls unexposed, NOS;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.87[0.82; 0.93]52,65413,4450%NASkalkidou (Controls unexposed, sick), 2020 Gungor (Controls unexposed, sick), 2019 Reis (Controls unexposed, NOS), 2010 Pastuszak - Fluoxetine (Controls unexposed, NOS), 1993 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.07[0.60; 1.94]46,2394,89352%NAReis (Controls unexposed, NOS), 2010 Pastuszak - Fluoxetine (Controls unexposed, NOS), 1993 2 unexposed, sickunexposed, sick 0.87[0.81; 0.93]6,4158,5520%NASkalkidou (Controls unexposed, sick), 2020 Gungor (Controls unexposed, sick), 2019 2 Tags Adjustment   - No  - No 1.05[0.63; 1.75]6,4398,63632%NASkalkidou (Controls unexposed, sick), 2020 Gungor (Controls unexposed, sick), 2019 Pastuszak - Fluoxetine (Controls unexposed, NOS), 1993 3   - Yes  - Yes 0.89[0.73; 1.08]46,2154,809 -NAReis (Controls unexposed, NOS), 2010 1 MatchedMatched 1.74[0.71; 4.23]2484 -NAPastuszak - Fluoxetine (Controls unexposed, NOS), 1993 1 Monotherapy   - no or not specified  - no or not specified 0.87[0.81; 0.93]6,4138,512 -NASkalkidou (Controls unexposed, sick), 2020 1   - SSRI only  - SSRI only 1.05[0.66; 1.68]46,2414,93324%NAGungor (Controls unexposed, sick), 2019 Reis (Controls unexposed, NOS), 2010 Pastuszak - Fluoxetine (Controls unexposed, NOS), 1993 3 Unexposed sick   - old history of illness/treatment (> ...  - old history of illness/treatment (> 12 months before pregnancy) or not specified 0.87[0.81; 0.93]6,4158,5520%NASkalkidou (Controls unexposed, sick), 2020 Gungor (Controls unexposed, sick), 2019 2 All studiesAll studies 0.87[0.82; 0.93]52,65413,4450%NASkalkidou (Controls unexposed, sick), 2020 Gungor (Controls unexposed, sick), 2019 Reis (Controls unexposed, NOS), 2010 Pastuszak - Fluoxetine (Controls unexposed, NOS), 1993 40.210.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.73.61.8860.000Skalkidou (Controls unexposed, sick), 2020Gungor (Controls unexposed, sick), 2019Reis (Controls unexposed, NOS), 2010Pastuszak - Fluoxetine (Controls unexposed, NOS), 1993

Asymetry test p-value = NaN (by Egger's regression)

not enought points

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 6999, 12918, 8158, 7473

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 0.88[0.84; 0.93]94,25613,4450%NASkalkidou (Controls unexposed, disease free), 2020 Gungor (Controls unexposed, disease free), 2019 Reis (Controls unexposed, NOS), 2010 Pastuszak - Fluoxetine (Controls unexposed, NOS), 1993 4 unexposed, sick controlsunexposed, sick controls 0.87[0.81; 0.93]6,4158,5520%NASkalkidou (Controls unexposed, sick), 2020 Gungor (Controls unexposed, sick), 2019 2 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.30[0.83; 2.06]1884,8490%NAGungor (Controls exposed to Mirtazapine), 2019 Reis (Controls exposed to TCA), 2010 20.510.01.0